NPN 125 FINAL EXAM WITH
CORRECT SOLUTION
PTSD - ANSWER Disturbing behavior due to exposure to traumatic events (natural
disaster, combat, assault) at least 3 months after trauma occurred
Three clusters of PTSD symptoms - ANSWER Reliving event; Avoiding reminders of
event; Being on guard or experiencing hyperarousal
When can PTSD occur? - ANSWER Can occur at any age
Adjustment Disordeer - ANSWER A reaction to a stressful event that causes problems
for the individuals; typically, the person has more than the expected difficulty coping
with or assimilating the event into his or her life
When do the symptoms for adjustment order develop? - ANSWER Within a month, lasting
no more than 6 months
What happens by 6 months of the adjustment disorder? - ANSWER It has either been
successful, or the person moves on to another diagnosis
Examples of adjustment disorder - ANSWER Financial, relationship, and work-related
stressors
Reactive Attachment Disorder - ANSWER Occurs before the age of 5 in response to the
trauma of child abuse or neglect; the child shows disturbed, inappropriate social
relatedness in most situations; the child with RAD exhibits minimal social and emotional
responses to others, lacks a positive affect, and may be sad, irritable, or afraid for no
apparent reason
Dissociation - ANSWER Subconscious defense mechanism used to protect emotional
self from recognizing full impact of some horrific or traumatic event by following mind to
forget or remove itself from painful situation or memory
Dissociative amnesia - ANSWER The client cannot remember important person
information (usually of a traumatic or stressful nature); includes a fugue experience
where the client suddenly moves to a new geographic location with no memory of past
events, and often the assumption of a new identity
Dissociate identity disorder (DID) - ANSWER Formerly multiple personality disorder; the
client displays two or mote distinct identities or personality states that recurrently take
control of his or her behavior; accompanied by the inability to recall important personal
information
Depersonalization disorder - ANSWER The client has a persistent or recurrent feeling of
,being detached from his or her mental processes or body
Derealization disorder - ANSWER Sensation of being in a dream-like states where the
environment seems doggy or unreal
PTSD and Dissociative Disorder treatment - ANSWER Community: Based group or
individual therapy
Cognitive behavioral therapy
Pharmacological treatment: Paroxetine, sertraline for PTSD
Symptomatic treatment for dissociative disorders (anti-anxiety, antidepressants)
Paroxetine - ANSWER PTSD medication
Sertraline - ANSWER PTSD medication
Anxiety - ANSWER Vague feeling of dread or apprehension
Anxiety - ANSWER Different from fear
Anxiety behaviors - ANSWER Panic without reason; unwarranted fear of objects or life
conditions; uncontrollable repetitive actions; re-experiencing of traumatic events;
unexplainable or overwhelming worry
Alarm reaction stage - ANSWER Preparation for defense
Resistance stage - ANSWER Blood shunted to areas needed for defense
Exhaustion stage - ANSWER Stores depleted; emotional components unresolved
Mild Anxiety (Peplau) - ANSWER Special attention; increased sensory stimulation;
motivational
Moderate Anxiety (Peplau) - ANSWER Something definitely wrong;
nervousness/agitation; difficulty concentrating; able to be redirected
Severe Anxiety (Peplau) - ANSWER Trouble thinking and reasoning; tightened muscles;
increased vital signs; restlessness; irritable; angry
Panic Anxiety (Peplau) - ANSWER Fight, flight, or freeze response; increased vital signs;
dilated pupils; cognitive processes focusing on defense
Ways to work with anxious clients - ANSWER Self-awareness of anxiety level;
assessment of person's anxiety level; use of short, simple, easy-to-understand
sentences; lower person's anxiety level to moderate or mild before proceeding; low,
calm soothing voice; safety during panic level; short-term use of anxiolytics
When does anxiety get diagnosed? - ANSWER When it becomes chronic and permeates
major portions of the person's life — signaling maladaptive behaviors and emotional
,stability
Anxiety is more prevalent in what gender/age? - ANSWER Women; people under 45
years of age
Most common psychiatric disorder in the US - ANSWER Anxiety
Why may anxiety be an inherited component? - ANSWER First-degree relatives of clients
with increased anxiety have higher rates of developing anxiety
Which disorders have moderate heritability? - ANSWER Panic disorder, social anxiety
disorder, agoraphobia
What is common in families? - ANSWER GAD, OCD
GABA - ANSWER The neurotransmitter believed to be dysfunctional in anxiety disorders
Serotonin - ANSWER The indolamine neurotransmitter usually implicated in psychosis
and mood disorders; believed to play a distinct role in OCD, panic disorder, and GAD
Subtype 5-Hydroxytryptamine type 1a - ANSWER Serotonin; Plays a role in anxiety,
affects aggression and mood
Intrapsychic/psychoanalytic theories - ANSWER Freud described defense mechanisms
as the humans attempt to control awareness of and to reduce anxiety; defense
mechanisms are cognitive distortions that a persons uses unconsciously to maintain a
sense of being in control of a situation, to lessen discomfort, and to deal with stress;
arise from the unconscious, the person is unaware of using them
Intrapersonal theories - ANSWER Sullivan viewed anxiety as being generated from
problems in interpersonal relationships. In adults, anxiety arises from the person's need
to conform to the norms and values of his or her cultural group. The higher the level of
anxiety, the lower the ability to communicate and to solve problems and the greater the
chance for anxiety disorders to develop
Behavioral theory - ANSWER Theorists view anxiety as being learned through
experiences; conversely, people can change or "unlearn" behaviors, through new
experiences; Behaviorists believe that people can modify maladaptive behaviors without
gaining insight into their causes
Positive reframing - ANSWER Turning negative messages into positive ones
Decatastrophizing - ANSWER Making more realistic appraisal of a situation
Assertiveness training - ANSWER Learn to negotiate interpersonal situations
Late-life anxiety disorders (elder considerations) - ANSWER Phobias (GAD most
common); often associated with another condition, such as depression, dementia,
physical illness, or med toxicity/withdrawal
, What is the tx of choice for elders with anxiety? - ANSWER SSRI's
What is anxiety a warning of? - ANSWER Not dealing with stress effectively
Tips for managing stress - ANSWER Positive attitude; belief in self; acceptable of lack of
control over certain events; assertive communication; expression of feelings: talking,
laughing, crying; realistic goals; personally, meaningful activity; well-balanced diet,
exercise, adequate rest/sleep; use of stress management
Panic disorder - ANSWER Discrete episodes of panic — no stimulus for panic response
— 15-30 minutes of rapid, intense, escalating anxiety where person experiences great
emotional fear and physiologic discomfort
Treatment for panic disorders - ANSWER Cognitive behavior techniques; deep
breathing, relaxation; benzodiazepines; SSRI's; tricyclic antidepressants;
antihypertensives (clonidine, propanolol)
Panic disorder assessment - ANSWER Hamilton rating scale for anxiety; history; general
appearance, motor behavior (automatisms); mood, affect (depersonalization,
derealization); thought process, content (disorganized thoughts, loss of rational
thinking); sensorium, intellectual process (confusion, disorientation); judgment, insight;
self-concept (self-blaming); roles, relationships (avoidance of others); physiologic,
self-care concerns (sleeping, eating)
Phobia - ANSWER Intense illogical persistent fear
Phobia categories - ANSWER Agoraphobia; specific phobia; social phobia (social
anxiety phobia)
Specific phobias - ANSWER Natural environment; blood-injection; situation; animal; etc
Phobia treatment - ANSWER Behavioral therapy; positive reframing; assertiveness
training; systematic desensitization; flooding
Generalized anxiety disorder - ANSWER Chronic; anxious at least 50% of the time for 6
months or more
Generalized anxiety disorder treatment - ANSWER Buspirone; SSRI's; SNRI's
Self awareness issues - ANSWER Need to understand how, why anxiety behaviors work;
nurses as vulnerable as others to stress and anxiety; everyone occasionally suffers from
stress, anxiety; avoid trying to "fix" clients problem; use techniques to manage stress,
anxiety in personal life
Obsessions - ANSWER Recurrent, persistent, intrusive, unwanted thoughts, images,
impulses causing marked anxiety and interfere with interpersonal, social, or
occupational function
Complusions - ANSWER Ritualistic or repetitive behaviors or mental acts carried out
CORRECT SOLUTION
PTSD - ANSWER Disturbing behavior due to exposure to traumatic events (natural
disaster, combat, assault) at least 3 months after trauma occurred
Three clusters of PTSD symptoms - ANSWER Reliving event; Avoiding reminders of
event; Being on guard or experiencing hyperarousal
When can PTSD occur? - ANSWER Can occur at any age
Adjustment Disordeer - ANSWER A reaction to a stressful event that causes problems
for the individuals; typically, the person has more than the expected difficulty coping
with or assimilating the event into his or her life
When do the symptoms for adjustment order develop? - ANSWER Within a month, lasting
no more than 6 months
What happens by 6 months of the adjustment disorder? - ANSWER It has either been
successful, or the person moves on to another diagnosis
Examples of adjustment disorder - ANSWER Financial, relationship, and work-related
stressors
Reactive Attachment Disorder - ANSWER Occurs before the age of 5 in response to the
trauma of child abuse or neglect; the child shows disturbed, inappropriate social
relatedness in most situations; the child with RAD exhibits minimal social and emotional
responses to others, lacks a positive affect, and may be sad, irritable, or afraid for no
apparent reason
Dissociation - ANSWER Subconscious defense mechanism used to protect emotional
self from recognizing full impact of some horrific or traumatic event by following mind to
forget or remove itself from painful situation or memory
Dissociative amnesia - ANSWER The client cannot remember important person
information (usually of a traumatic or stressful nature); includes a fugue experience
where the client suddenly moves to a new geographic location with no memory of past
events, and often the assumption of a new identity
Dissociate identity disorder (DID) - ANSWER Formerly multiple personality disorder; the
client displays two or mote distinct identities or personality states that recurrently take
control of his or her behavior; accompanied by the inability to recall important personal
information
Depersonalization disorder - ANSWER The client has a persistent or recurrent feeling of
,being detached from his or her mental processes or body
Derealization disorder - ANSWER Sensation of being in a dream-like states where the
environment seems doggy or unreal
PTSD and Dissociative Disorder treatment - ANSWER Community: Based group or
individual therapy
Cognitive behavioral therapy
Pharmacological treatment: Paroxetine, sertraline for PTSD
Symptomatic treatment for dissociative disorders (anti-anxiety, antidepressants)
Paroxetine - ANSWER PTSD medication
Sertraline - ANSWER PTSD medication
Anxiety - ANSWER Vague feeling of dread or apprehension
Anxiety - ANSWER Different from fear
Anxiety behaviors - ANSWER Panic without reason; unwarranted fear of objects or life
conditions; uncontrollable repetitive actions; re-experiencing of traumatic events;
unexplainable or overwhelming worry
Alarm reaction stage - ANSWER Preparation for defense
Resistance stage - ANSWER Blood shunted to areas needed for defense
Exhaustion stage - ANSWER Stores depleted; emotional components unresolved
Mild Anxiety (Peplau) - ANSWER Special attention; increased sensory stimulation;
motivational
Moderate Anxiety (Peplau) - ANSWER Something definitely wrong;
nervousness/agitation; difficulty concentrating; able to be redirected
Severe Anxiety (Peplau) - ANSWER Trouble thinking and reasoning; tightened muscles;
increased vital signs; restlessness; irritable; angry
Panic Anxiety (Peplau) - ANSWER Fight, flight, or freeze response; increased vital signs;
dilated pupils; cognitive processes focusing on defense
Ways to work with anxious clients - ANSWER Self-awareness of anxiety level;
assessment of person's anxiety level; use of short, simple, easy-to-understand
sentences; lower person's anxiety level to moderate or mild before proceeding; low,
calm soothing voice; safety during panic level; short-term use of anxiolytics
When does anxiety get diagnosed? - ANSWER When it becomes chronic and permeates
major portions of the person's life — signaling maladaptive behaviors and emotional
,stability
Anxiety is more prevalent in what gender/age? - ANSWER Women; people under 45
years of age
Most common psychiatric disorder in the US - ANSWER Anxiety
Why may anxiety be an inherited component? - ANSWER First-degree relatives of clients
with increased anxiety have higher rates of developing anxiety
Which disorders have moderate heritability? - ANSWER Panic disorder, social anxiety
disorder, agoraphobia
What is common in families? - ANSWER GAD, OCD
GABA - ANSWER The neurotransmitter believed to be dysfunctional in anxiety disorders
Serotonin - ANSWER The indolamine neurotransmitter usually implicated in psychosis
and mood disorders; believed to play a distinct role in OCD, panic disorder, and GAD
Subtype 5-Hydroxytryptamine type 1a - ANSWER Serotonin; Plays a role in anxiety,
affects aggression and mood
Intrapsychic/psychoanalytic theories - ANSWER Freud described defense mechanisms
as the humans attempt to control awareness of and to reduce anxiety; defense
mechanisms are cognitive distortions that a persons uses unconsciously to maintain a
sense of being in control of a situation, to lessen discomfort, and to deal with stress;
arise from the unconscious, the person is unaware of using them
Intrapersonal theories - ANSWER Sullivan viewed anxiety as being generated from
problems in interpersonal relationships. In adults, anxiety arises from the person's need
to conform to the norms and values of his or her cultural group. The higher the level of
anxiety, the lower the ability to communicate and to solve problems and the greater the
chance for anxiety disorders to develop
Behavioral theory - ANSWER Theorists view anxiety as being learned through
experiences; conversely, people can change or "unlearn" behaviors, through new
experiences; Behaviorists believe that people can modify maladaptive behaviors without
gaining insight into their causes
Positive reframing - ANSWER Turning negative messages into positive ones
Decatastrophizing - ANSWER Making more realistic appraisal of a situation
Assertiveness training - ANSWER Learn to negotiate interpersonal situations
Late-life anxiety disorders (elder considerations) - ANSWER Phobias (GAD most
common); often associated with another condition, such as depression, dementia,
physical illness, or med toxicity/withdrawal
, What is the tx of choice for elders with anxiety? - ANSWER SSRI's
What is anxiety a warning of? - ANSWER Not dealing with stress effectively
Tips for managing stress - ANSWER Positive attitude; belief in self; acceptable of lack of
control over certain events; assertive communication; expression of feelings: talking,
laughing, crying; realistic goals; personally, meaningful activity; well-balanced diet,
exercise, adequate rest/sleep; use of stress management
Panic disorder - ANSWER Discrete episodes of panic — no stimulus for panic response
— 15-30 minutes of rapid, intense, escalating anxiety where person experiences great
emotional fear and physiologic discomfort
Treatment for panic disorders - ANSWER Cognitive behavior techniques; deep
breathing, relaxation; benzodiazepines; SSRI's; tricyclic antidepressants;
antihypertensives (clonidine, propanolol)
Panic disorder assessment - ANSWER Hamilton rating scale for anxiety; history; general
appearance, motor behavior (automatisms); mood, affect (depersonalization,
derealization); thought process, content (disorganized thoughts, loss of rational
thinking); sensorium, intellectual process (confusion, disorientation); judgment, insight;
self-concept (self-blaming); roles, relationships (avoidance of others); physiologic,
self-care concerns (sleeping, eating)
Phobia - ANSWER Intense illogical persistent fear
Phobia categories - ANSWER Agoraphobia; specific phobia; social phobia (social
anxiety phobia)
Specific phobias - ANSWER Natural environment; blood-injection; situation; animal; etc
Phobia treatment - ANSWER Behavioral therapy; positive reframing; assertiveness
training; systematic desensitization; flooding
Generalized anxiety disorder - ANSWER Chronic; anxious at least 50% of the time for 6
months or more
Generalized anxiety disorder treatment - ANSWER Buspirone; SSRI's; SNRI's
Self awareness issues - ANSWER Need to understand how, why anxiety behaviors work;
nurses as vulnerable as others to stress and anxiety; everyone occasionally suffers from
stress, anxiety; avoid trying to "fix" clients problem; use techniques to manage stress,
anxiety in personal life
Obsessions - ANSWER Recurrent, persistent, intrusive, unwanted thoughts, images,
impulses causing marked anxiety and interfere with interpersonal, social, or
occupational function
Complusions - ANSWER Ritualistic or repetitive behaviors or mental acts carried out
